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ADMINISTRATIVE CHANGE FORM PUBLIC OR SEMI-PUBLIC SWIMMING POOL OR SPA
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ENVIRONMENTAL SERVICES
DEPARTMENT
Darcy Kober, Director
WATER AND WASTE MANAGEMENT
DIVISION
Eric Matson, PE, Division Manager
ADMINISTRATIVE CHANGE FORM
PUBLIC OR SEMI-PUBLIC SWIMMING POOL OR SPA
Permits are not transferable. This form can be used to change/update the management company or/and billing address. If the owner has changed, please complete the "New Owner Application" online form below.
New Owner Application
New Owner Application
FACILITY INFORMATION
1. Facility Name:
*
2. Facility/Pool Address:
*
City:
*
Zip:
*
3. Facility Contact Name:
*
Phone #:
*
4. Email Address:
*
OWNER’S INFORMATION
5. OWNERS Name*:
*
*Owner listed should match what is listed on business license and tax id and should not be a management company. Please provide Home/Condo Owners information if applicable.
Phone #:
*
6. Address:
*
FAX #:
7. City:
*
State:
*
Zip:
*
8. Email Address:
*
9. Electronic Signature Agreement
*
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
I agree.
Owner Signature:
*
BILLING/MAILING INFORMATION
10. CONTACT Name:
*
Phone #:
*
11. Management Company/Agent Name:
*
Phone #:
12. Address:
*
FAX #:
13. City:
*
State:
*
Zip:
*
14. Email Address:
*
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